Steroidowrażliwość oraz steroidooporność w dziecięcym idiopatycznym zespole nerczycowym – czy zaszła zmiana na przestrzeni dwóch dekad?

Abstract

BackgroundIt is widely known that childhood idiopathic nephrotic syndrome (INS) seems to be benign, mostly minimal change glomerulopathy, sensitive to steroids with the tendency to relapse. There are reports that the histopathology and response to treatment in INS may be changing. AimThe aim of the study was to search for changes in the characteristics of the steroid sensitivity and steroid resistance in childhood INS within twenty years. Material and methodsRetrospective chart analysis was done to identify all children with new-onset nephrotic syndrome admitted to the Division of Pediatric Nephrology in Zabrze within 1986–2005. Comparison of clinical characteristics and histopathology in subgroups of steroid sensitive 59 vs 66 and steroid resistant 17 vs 36 patients in two following decades was performed. ResultsIn a group of steroid sensitive patients no significant difference in clinical characteristics at onset apart from increasing frequency of hematuria 16.9% vs 40.9%, p = 0.0034 was found. The frequency of renal biopsy as well as the frequency of relapses didn’t differ significantly in this group. In a group of steroid resistant patients the only clinical feature that differed significantly was a decrease in number of patients with hypertension 70.6% vs 38.9%, p = 0.031. There was no significant difference in histopathology of steroid resistant nephrotic syndrome with only slight increase in focal segmental glomerulosclerosis (FSGS) 17.6% vs 25%, p = 0.73 and mesangio-proliferative glomerulonephritis (MesPGN) 35.3% vs 47.2%, p = 0.41. ConclusionsIn analyzed population besides the increasing rate of hematuria in steroid sensitive patients and the decreasing rate of hypertension in steroid resistant patients, there have been no other changes in clinical and histopathological characteristics of steroid sensitivity and steroid resistance in childhood INS within the period of twenty years.